It is coming under control, but there are a few risky senarios available still. It is nasty, it is drug resistant to ciprofloxacin, which is the main plague treatment to date and it is mostly pneumonic which is also undesirable. Plague is endemic to Madagascar, but this is the first time it has entered the big cities,

Now the good news: the WHO and MSF have thrown the book at it, with big funding from the WHO for antibiotics, the numbers of cases are dropping, Azithromycin works on the bug, and Madagascar is an island, which also helps to contain things.

So, the risks are diminishing, but have not gone away yet. The "it's all over." brigade and the "It's the end of the world!" brigade are both wrong. It is being contained, but the job is not done yet and there are still some risks to global health.

There must be a lot of diseases around-journalism seem more often unable to get to the real news. When you look at Ebola in 2016, plague this year-the problems are very large and getting more dangerous by the day. Bad reporting worsens the health-crisis.

Que sera, sera, Whatever will be, will be, The future is not ours to see, Que sera, sera !

Although ciprofloxacin o longer works on this plague strain, azithromycin does. The WHO shiped MASSES of antibiotics into the area. I presume that they are applying some of that prophylaxically, an option not available in viral cases, like flu. Even when it is airborne, if EVERYWHERE is covered in disinfectant residue, other vectors are eradicated and all the people are rendered immune by virtue of pre-treatment, then there is nowhere for it to go.

Whatever they are doing, it seems to be working, slowly but surely.

Yes, Josh. Some of the tabloids are indulging in immense hyperbole. I guess the word "plague" is just too juicy to resist.

Just relaying the info in one of the articles I posted a week or so ago. Your choice makes more sense though. Levofloxacin is a stereoisomer/analogue of cipro and as so, would make more biological sense.

In the case of an aerosolized plague weapon, the United States Working Group of Civilian Biodefense recommended streptomycin or gentamicin as the preferred choice in a contained casualty setting (i.e., modest numbers of patients requiring treatment), with doxycycline, ciprofloxacin, or chloramphenicol as alternative choices. For a mass casualty situation, oral therapy with doxycycline, tetracycline, or ciprofloxacin has been recommended (16). Prevention of human-to-human transmission from patients with plague pneumonia can be achieved by implementing standard isolation procedures until at least 4 days after the initiation of antibiotic treatment (3).

I was on my way back from the airport early this morning, and I stopped into the supermarket which was almost empty, and there in the fresh food aisle was a very short woman who sneezed twice right onto the produce. I thought then, someone will come in here in a little while and pick up one of those items and go home with the flu.

I can't think of anyway to stop airborne viruses. I'm off on a flight first thing tomorrow and no amount of disinfecting my tray table will stop a virus if someone sneezes in my face.

What personal protective equipment should emergency responders use when responding to a potential bio-attack involving plague? How should workers decontaminate themselves if they think they have been exposed to plague?

In a covert attack involving aerosolized plague, there would be no emergency response activity involving emergency responders. The first evidence that a potential attack had occurred would be diagnosis of the disease among exposed individuals, which would happen several days after the actual release. However, it is possible that emergency responders would be required to respond to a bio-attack incident, such as notification regarding an aerosol dissemination device or other suspicious release. The following references provide additional information regarding PPE, decontamination, and other precautions for emergency responders to consider during such an incident.

Chuck, do you think a smallpox vaccine gives immunity for life? I was one of the last to get the vaccine, would it still protect me? Would I have passed on that immunity to my children? Thanks.

Good question, KiwiMum! Childhood smallpox vaccine likely confers at least some lifelong protection, so even if you were to be exposed and become an active case, your infection would likely be less severe than an unvaccinated person.

I was vaccinated twice....once as a kid (I'm 62), and again in 1979, when I went on an overseas trip that included Turkey and Egypt, before smallpox was announced as eradicated. I am reasonably confident that I have lifelong immunity.

The smallpox vaccine (vaccinia virus) is no laughing matter....it can have serious/life-threatening complications:

In the 1960s, serious adverse events associated with smallpox vaccination in the United States included death (1/million vaccinations), progressive vaccinia (1.5/million vaccinations), eczema vaccinatum (39/million vaccinations), postvaccinial encephalitis (12/million vaccinations), and generalized vaccinia (241/million vaccinations).20 Adverse events were approximately ten times more common among those vaccinated for the first time compared to revaccinees.20 Fatality rates were also four times higher for primary vaccinees compared to revaccinees.21

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